Intra-pleural chest drains are used to treat a child with a collection of fluid or air in the pleural space. This may be due to one of the following clinical conditions:
simple pneumothorax
tension pneumothorax
haemothorax
pleural effusion
chylothorax
emphysema.
Following thoracic or cardiac surgery, a chest drain may also be required.
Intra-pleural chest drains are inserted into the apical pleural space to remove air, or inserted into the basal pleural space to remove fluid. Children requiring a chest drain should be nursed in a high dependency care area. Insertion of the chest drain should be carried out in a tertiary respiratory centre, if their condition permits safe transfer for this procedure.
Once the chest drain has been inserted into the intra-pleural space, it will be attached to drainage tubing that leads into a drainage bottle. The end of this drainage tube will be below the water level. This creates a siphon effect, air or fluid is drawn from the pleural space to the lower level. It is the water in the bottle that creates the underwater seal. This underwater seal prevents air from entering the pleural space. A second tube leads from the drainage bottle. This second tube will either be on low suction or will remain open to the air.
The chest drain is secured to the chest wall by a purse string suture. A sterile waterproof dressing should be applied over the suture.
Position of the chest drain catheter is confirmed by chest X-ray.
The drainage tube should be checked hourly and the amount of fluid drained should be recorded. The colour of the fluid should be noted. If there is any increase in the volume of fluid draining, if it becomes blood-stained or if it changes in any way, this will necessitate immediate reporting to medical staff.
The drainage bottle should be observed at least hourly for a ‘swinging’ motion to the water. This is due to air leaving the pleural space. This swinging motion decreases as the lung inflates.
The level of sterile water in the drainage bottle should be recorded on insertion of the chest drain and should not be below the minimum level.
The amount of fluid (exudate and sterile water) in the drainage bottle should not be more than three-quarters full at any time.
Aseptic non-touch technique should be employed when changing the bottle.
The chest tube must be clamped when the bottle is being changed to prevent air entering the pleural cavity via the chest drain.
Note the amount of sterile water in the bottle when it is connected to the chest drain.
Where possible, the child should be nursed upright and supported with pillows.
Vital signs should be recorded as indicated by the child’s condition; this should include heart rate, respiratory rate, and oxygen saturation percentage. Temperature should be recorded as a minimum every four hours.
The work of breathing should be noted, as should the child’s colour. Chest movement should be equal. Any shortness of breath or gasping must be reported to medical staff at once.
Analgesia should be administered as prescribed and its effectiveness noted.
A keyhole dressing should be in situ over the entry site. The dressing should prevent air from entering the chest cavity. Aseptic non-touch technique should be used for dressing changes and the wound should be kept dry.
Two clamps must be available at the bedside (flat edges) in case the drainage bottle becomes disconnected.
If low suction is required, then a low suction unit should be made available.
Medical staff must prescribe the amount of suction.
Mobilization is encouraged.
Physiotherapy may be indicated and care will need to be implemented accordingly.
A chest X-ray will be required before the removal of the chest drain to ensure the lung has reinflated.
Removal of the drain will require the suture to be untied. As this is being pulled closed, the drain will be pulled out gently. The co-operation of the child is essential as they will be required to breathe out as the drain is removed. They need to be in a sitting position, leaning forward on a bed table. Analgesia should be administered prior to removal of the drain.
An occlusive dressing should be applied over the drain site.
The sutures should be removed as per medical advice. Aseptic non-touch technique should be used.
Only gold members can continue reading. Log In or Register to continue
